tbuckley/cabot-search huggingface dataset:
POS0058 OBESITY ASSOCIATES WITH HIGHER LEVELS OF INFLAMMATION DURING THE DISEASE COURSE, BUT ONLY IN ACPA-POSITIVE RA
Authors: N. Den Hollander, A. M. P. Boeren, A. Van der Helm – van Mil, H. W. Van Steenbergen
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Obese rheumatoid arthritis(RA) patients have higher disease activity scores(DAS) and lower odds of achieving remission. Although it has been convincingly shown that obese RA-patients experience more pain and have lower wellbeing scores, results are conflicting whether obesity has "pro-inflammatory effects" measured by higher swollen joint count(SJC) and CRP-levels. Additionally, associations of obesity with the DAS-components have not been studied longitudinally and it is unknown whether "pro-inflammatory effects" are similarly present in ACPA-positive and -negative RA. As in vitro data suggested that ACPA can enhance inflammatory-responses, we hypothesized that the association of obesity with SJC and CRP is strongest in ACPA-positive RA. <h3>Objectives</h3> To increase the understanding regarding the effect of obesity on the course of disease activity by studying associations of obesity with DAS-components in ACPA-positive and ACPA-negative RA. <h3>Methods</h3> We studied 649 RA-patients (358 ACPA-positive, 291 ACPA-negative), consecutively included in Leiden Early Arthritis Clinic from May 2011 onwards, and with a total of 2871 DAS-measurements over 5 years. Courses of DAS44 and DAS-components (SJC-44, TJC-53, CRP and VAS(0-100)) were compared between RA-patients with normal weight (BMI 18.5-24.9; reference category), overweight (25.0-29.9) and obese patients(≥30.0), stratified for ACPA-positivity. Linear mixed models and Poisson mixed models with a knot at 4 months were used. <h3>Results</h3> Obese patients had a 0.32 units higher DAS compared to normal weight at diagnosis, this persisted during follow-up. Stratification for ACPA revealed that obese ACPA-positive patients had a 0.43 units(95%CI 0.22,0.64) higher DAS over time, whereas this difference was smaller and not statistically significant in ACPA-negative RA (0.19 units; 95%CI -0.01, 0.38). In ACPA-positive RA, all DAS-components were significantly higher during all 5 years of follow-up in obese patients compared to normal weight: SJC +60% (IRR1.60; 95%CI 1.18, 2.16), CRP +3.7mg/L (95%CI 0.95, 6.53), TJC +55% (IRR1.55; 95%CI 1.15, 2.10) and VAS +9 units (95%CI 4.09, 14.16; Figure 1). However, in ACPA-negative RA, obese patients only had a statistically non-significant trend towards (22%) higher TJC (IRR1.22; 95%CI 0.96, 1.55) and (4 units) higher VAS (95%CI -0.41, 9.00). Moreover, in ACPA-negative RA obesity was not associated with higher SJC and CRP. <h3>Conclusion</h3> Although obesity confers risk for higher DAS-scores over time, the effects of obesity on higher SJC and CRP-levels are restricted to ACPA-positive RA. This is the first demonstration that the influence of obesity on the course of RA is different for the two RA-subtypes. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0172 ARTERIAL STIFFNESS IN ANTIPHOSPHOLIPID SYNDROME: COMPARISON WITH DIABETES MELLITUS AND HEALTHY CONTROLS
Authors: G. Evangelatos, G. Konstantonis, N. Tentolouris, P. Sfikakis, M. Tektonidou
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with Antiphospholipid Syndrome (APS) carry an increased burden of cardiovascular morbidity and mortality and have higher prevalence of traditional cardiovascular risk factors (CVRFs) and subclinical atherosclerosis [1]. Arterial stiffness (ArS) has emerged as an independent predictor of future cardiovascular events and death in the general population, beyond the effect of traditional CVRFs [2]. <h3>Objectives</h3> We aimed to compare ArS measures in thrombotic APS patients and age- and sex-matched patients with diabetes mellitus (DM) and healthy controls (HC), and identify potential predictors of increased ArS in patients with APS. <h3>Methods</h3> ArS was evaluated by carotid-femoral Pulse Wave Velocity (cfPWV) and Augmentation Index normalized to 75 beats per minute (AIx@75) using the SphygmoCor device. All participants also underwent ultrasound examination of the carotid and femoral arteries for the detection of atherosclerotic plaques. Multivariate analysis was applied for comparing ArS measures between groups and for the assessment of ArS predictors in the APS group. <h3>Results</h3> One-hundred and ten APS patients (70.9% female, mean age: 45.4 years), and equal numbers of DM patients and HC were included. After adjustment for age, sex, traditional CVRFs and atherosclerotic plaque presence, APS exhibited similar cfPWV (p=0.456) but increased AIx@75 (beta=4.640, 1.668-7.611, p=0.002) versus HC. APS patients had lower cfPWV (p&lt;0.001) but similar AIx@75, (p=0.150) compared to DM patients. Using multiple linear regression analysis, cfPWV in APS group was independently associated with age (beta=0.056, 0.034-0.078, p&lt;0.001), mean arterial pressure (MAP) (beta=0.070, 0.043-0.097, p&lt;0.001), atherosclerotic plaques in femoral arteries (beta=0.732, 0.053-1.411, p=0.035) and anti-β2GPI IgM positivity (beta=0.696, 0.201-1.191, p=0.006). AIx@75 was associated with age (beta=0.334, 0.117-0.551, p=0.003), female sex (beta=7.447, 2.312-12.581, p=0.005) and MAP (beta=0.425, 0.187-0.663, p=0.001). <h3>Conclusion</h3> Patients with APS exhibit comparable cfPWV to healthy individuals but elevated AIx@75, similar to DM, implying impaired vascular health in APS. Age, female sex, MAP, atherosclerotic plaques and anti-β2GPI IgM are linked with enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS patients. <h3>References</h3> [1]Tektonidou MG. Cardiovascular disease risk in antiphospholipid syndrome: Thrombo-inflammation and atherothrombosis. J Autoimmun. 2022;128:102813. [2]Vlachopoulos C et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Atherosclerosis. 2015;241(2):507-32. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0028 COMPARATIVE STUDY BETWEEN THE VITACORA AND PSAID QUESTIONNAIRES IN ESTIMATING QUALITY OF LIFE IN PATIENTS WITH PSORIATIC ARTHRITIS
Authors: I. Braña Abascal, S. Burger, P. González del Pozo, E. Pardo Campo, S. Alonso Castro, M. Alperi-López, R. Queiró Silva
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Health-related quality of life (HRQoL) is a frequently underestimated aspect in psoriatic arthritis (PsA). There are different instruments to estimate HRQoL in PsA, but they are rarely used. <h3>Objectives</h3> Our objective was to compare the clinimetric capabilities of the VITACORA<sup>[1]</sup> and PsAID<sup>[2]</sup> (Psoriatic Arthritis Impact of Disease) questionnaires to assess HRQoL in PsA routine management. <h3>Methods</h3> Forty-five consecutive patients with PsA were recruited, mean age 55 ± 13 years, mean disease duration 8.2 ± 6.1 years, 24 men and 21 women. Disease activity was estimated using DAPSA (Disease Activity index for PsA), and HRQoL using VITACORA and PsAID. The construct and discriminant validity of the VITACORA (Pearson correlation and ROC curves) was analyzed. It must be taken into account that in the VITACORA questionnaire, the higher the value, the better the HRQoL, while in the PsAID the exact opposite occurs. Statistical significance was established at a p value &lt; 0.05. The statistical software R was used. <h3>Results</h3> Fifty-eight percent and 42% of the subjects were under biological and conventional systemic therapy, respectively. Most patients showed good control of their disease, median DAPSA 11.3 (IQR: 8.02-19.3), median PsAID 2.71 (IQR: 1.06-5). The correlation between VITACORA and PsAID was high, r: -0.7 (95% CI: -0.84 to -0.46), p&lt;0.0001, Figure 1. The VITACORA values ranged from 6 to 94. The discriminant validity determined that a VITACORA in the range 6-29 corresponded to a DAPSA high disease activity, a range 30-44 corresponded to a DAPSA moderate activity, and a range 45-95 corresponded with low DAPSA activity. The cut-off to determine an acceptable symptomatic state (PsAID ≤4) corresponded to a VITACORA value ≥ 66 with an area under ROC curve of 0.85 (95%CI: 0.71-0.98). <h3>Conclusion</h3> The VITACORA questionnaire has good discriminant and construct validity, and its clinimetric performance is similar to the PsAID in estimating HRQoL in clinical routine. Either of the two questionnaires could be used to assess this aspect of health in PsA. A VITACORA value ≥ 66 could be a good treatment target. <h3>References</h3> [1]Torre-Alonso JC et al. J Rheumatol 2014; 41(10):2008-17. [2]Gossec L et al. Ann Rheum Dis 2014; 73(6):1012-9. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0227 IMPROVEMENTS AND CHALLENGES OF SYSTEMIC LUPUS ERYTHEMATOSUS ASSOCIATED PULMONARY ARTERIAL HYPERTENSION: A 10-YEAR MULTICENTER COHORT STUDY
Authors: X. Dong, J. Qian, J. L. Zhao, Q. Wang, M. LI, X. Zeng
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Previous studies have described improved survival in systemic sclerosis (SSc) associated pulmonary arterial hypertension (PAH)[1-2], yet it is unclear whether survival of systemic lupus erythematosus (SLE) associated PAH has also improved. <h3>Objectives</h3> To describe the CSTAR prospective cohort of SLE-PAH patients, explore changes in characteristics, treatment and 5-year survival in the last decade, and possible reasons for survival change. <h3>Methods</h3> A multicenter prospective cohort of SLE-PAH was established, and divided into cohort A (2011.6-2016.5) and cohort B (2016.6-2021.5) according to the date of their baseline right heart catheterization (RHC). Another singlecenter cohort of idiopathic pulmonary arterial hypertension (IPAH) was consecutively recruited as control to describe the baseline characteristic and survival of SLE-PAH patients simultaneously. Disease characteristics, treatment regimen, and all-cause mortality were compared between cohort A and cohort B. Multi-variable cox regression was used to analyze association between treatment goal achievement and survival. <h3>Results</h3> A total of 610 SLE-PAH and 104 IPAH patients were enrolled. Overall, SLE-PAH patients were younger, predominantly female, had lower NT-proBNP level, better function status, better hemodynamic, and higher 5-year survival than IPAH (81.2% vs 56.0%, p&lt;0.001). Compared with cohort A, patients in cohort B showed lower mPAP and PVR, higher CI, and were more likely to receive intensive immunosuppressants and PAH-targeted medication. 5-year survival rate was also higher in cohort B (88.1% vs 72.9%, p=0.01). In multivariable Cox regression, treatment goal achievement of PAH (HR 0.31, 95%CI 0.12-0.81, p=0.017) and reaching lupus low disease activity state (LLDAS) (HR 0.23, 95%CI 0.08-0.67, p=0.007) were both independently associated with a lower mortality. <h3>Conclusion</h3> This is the largest muticenter prospective SLE-PAH cohort to describe disease characteristics and prognosis. This study showed that survival has improved significantly for SLE-PAH. Early detection of PAH in SLE patients, achieving PAH treatment goal as well as LLDAS for SLE contributed to survival improvement. <h3>References</h3> [1]Kolstad KD, Li S, Steen V, Chung L, Investigators P. Long-Term Outcomes in Systemic Sclerosis-Associated Pulmonary Arterial Hypertension From the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma Registry (PHAROS). Chest 2018; 154: 862-871. [2]Hassan HJ, Naranjo M, Ayoub N, Housten T, Hsu S, Balasubramanian A, Simpson CE, Damico RL, Mathai SC, Kolb TM, Hassoun PM. Improved Survival for Patients with Systemic Sclerosis-associated Pulmonary Arterial Hypertension: The Johns Hopkins Registry. Am J Respir Crit Care Med 2022. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0060-PARE UNDERSTANDING THE PATIENT PERSPECTIVE IN LIVING WITH AND TREATING SPONDYLOARTHRITIS
Authors: H. Lapidus Glassner, B. Schneider, E. Luce, E. Peacock
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondyloarthritis (SpA), the group of conditions that includes ankylosing spondylitis, psoriatic arthritis, and non-radiographic axial spondyloarthritis, among others, can lead to symptoms of pain, stiffness, and swelling. The burden of disease can affect patients' quality of life. <h3>Objectives</h3> Patient research was undertaken to explore the impact of spondyloarthritis on quality of life, patients' ability to manage the disease, as well as experiences with healthcare providers. Better understanding is crucial to improving HCP-patient interactions, helping patients get on the right treatment path, and improving health outcomes. <h3>Methods</h3> In July 2022 an email invitation to an online survey was sent to members of MySpondylitisTeam, a social network of over 88,000 people. In total, 361 members completed the 25-question survey. <h3>Results</h3> 92% of members report that spondyloarthritis interrupts their quality of life (62% strongly agree and 30% somewhat agree) (Figure 1). SpA takes both a physical and emotional toll. 88% report it makes it hard to do everyday activities (54% strongly agree and 34% somewhat agree). Symptoms extend well beyond lower back, joint and hip pain (92%, 84%, and 81% experienced in the past year respectively). Virtually all experience fatigue (91%). Additionally, 61% have experienced symptoms of depression (63%) or anxiety (61%) in the past year. At the same time, just 52% believe they can ask doctors and have meaningful discussions about SpA and how best to manage it (27% strongly agree and 25% somewhat agree) (Figure 2). Only 35% are satisfied with the care they receive from the doctor who primarily treats their SpA. 38% indicate that the doctor recommends treatment based on their personal needs, and 36% indicate that the doctor addresses their SpA symptoms. How much do you agree or disagree with each of the following statements? <i>(Sample=361</i>) <h3>Conclusion</h3> Understanding the needs of SpA patients provides significant opportunities for rheumatologists and primary care physicians to better support and educate their patients. This includes discussing potential treatment options, listening to patient concerns, and acknowledging the mental health challenges. <h3>References</h3> None to report. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0158 PRODUCTION OF REACTIVE OXYGEN SPECIES IS PRIMED IN BLOOD NEUTROPHILS FROM GOUT PATIENTS
Authors: L. Davidsson, L. Björkman, K. Christenson, A. Dahlstrand Rudin, J. Bylund
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gout is the most common inflammatory arthritis worldwide (1) and disease flares are triggered by the deposition of monosodium urate (MSU) crystals in and around the joints as a result of oversaturation of uric acid (urate) in the bloodstream. Macrophages phagocytose the crystals, leading to inflammasome activation and production of proinflammatory cytokines, mainly IL-1β. Neutrophils are recruited to the gouty inflamed site where they phagocytose the crystals, produce reactive oxygen species (ROS) and cast out neutrophil extracellular traps (NETs), the latter proposed to possess both pro- and anti-inflammatory properties in gout (2, 3). Gout patients have an increased risk for cardiovascular disease (4), and it is a paradox that uric acid, the major risk factor for gout and known to possess antioxidative properties, correlates with conditions associated with oxidative stress, such as cardiovascular disease. How urate levels in circulation affects neutrophil ROS production is unclear. <h3>Objectives</h3> To investigate whether peripheral neutrophils from gout patients respond to MSU crystals similarly as neutrophils form healthy controls. <h3>Methods</h3> Patients with polyarticular gout, diagnosed by a rheumatologist and identified at the Rheumatology Unit at Sahlgrenska University hospital and matched controls were included in the study. Peripheral blood from patients and controls were collected. Circulating blood neutrophils were isolated and intracellular ROS production was detected with luminol-amplified chemiluminescence. Quantification of NET Formation was performed by a fluorescence assay. Expression of surface markers was assessed by flow cytometry [5]. <h3>Results</h3> MSU crystals stimulated neutrophils from gout patients to produce intracellular ROS and the response in neutrophils from gout patients was significantly higher as compared to the ROS response in control neutrophils. Neutrophils derived from gout patients were not primed with regard to cell surface markers and NET formation. <h3>Conclusion</h3> Blood neutrophils from gout patients display increased ROS responses both at baseline and upon MSU crystal stimulation. It is possible that small circulating MSU crystals in peripheral blood of gout patients increase neutrophil responsiveness and give rise to the enhanced background activity seen in our ROS experiments. Another explanation could be that pro-inflammatory cytokines in the bloodstream of patients with gout rime neutrophils to produce increased amounts of ROS. <h3>References</h3> [1] Dehlin M, et al., BMC Musculoskelet Disord. 2015 [2] Schauer C, et al., Nat Med. 2014 [3] Chatfield SM, et al., J Innate Immun. 2018 [4] Vedder D et al., Arthritis Res Ther. 2020 [5] Davidsson L, et al., Int J Mol Sci. 2020 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0045 CHILDHOOD INFECTIONS AND PERINATAL FACTORS AS RISK FACTORS FOR ANKYLOSING SPONDYLITIS – RESULTS FROM A NATIONWIDE CASE-CONTROL STUDY
Authors: M. Morin, U. Lindström, K. Hellgren, T. Frisell
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> A growing body of evidence suggests that there are associations between perinatal factors or early life exposures and later development of chronic inflammatory diseases. For ankylosing spondylitis (AS), previous studies have found increased risks associated with birth order and childhood respiratory tract infections, while breast-feeding and childhood appendicitis have been found protective. <h3>Objectives</h3> To identify early life risk factors for AS, with focus on perinatal characteristics and childhood infections. <h3>Methods</h3> People with AS from the Swedish National Patient Register, born 1973-2004, were matched 1:5 on age, sex, and place of residence to general population controls. Conditional logistic regression was used to compare odds ratios for AS in relation to potential risk factors identified in the Medical Birth Register and the National Patient Register. <h3>Results</h3> People with AS (n=5427) had significantly more hospitalizations for infections before age 16 compared to controls (n=21523), and had more often gone through a tonsillectomy (table 1). People with AS were also more likely to be born in the winter months, and to have an older sibling, while having a sibling overall (older or younger) resulted in an odds ratio for AS of 1.01 (0.93-1.11). No association was seen with factors such as maternal age, Caesarean delivery, or a 1 SD change in weight for gestational age (table 1). Odds ratios for AS associated with being born small or large for gestational age (&gt;2 SD below or above sex-specific mean weight) was 1.10 (0.93-1.30) and 0.89 (0.74-1.08), respectively. In line with previous data, childhood appendectomy was associated with an odds ratio &lt;1, but the estimate did not reach statistical significance. <h3>Conclusion</h3> Childhood exposures related to infections seem to play a role in later development of AS, while factors generally associated with foetal growth do not. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0290 WORSE OUTCOMES LINKED TO ETHNICITY FOR THE EARLY TREATMENT OF REFRACTORY SLE: RESULTS FROM THE BILAG-BR
Authors: S. Dyball, M. Rodziewicz, E. Sutton, B. Parker, I. N. Bruce
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> SLE more commonly affects non-White populations who suffer higher disease activity and greater damage accrual. <h3>Objectives</h3> To describe differential response of patients with moderate-severe SLE in the UK by ethnic background. <h3>Methods</h3> Patients commencing rituximab (RTX), belimumab or a standard of care medication (SoC) for SLE in the BILAG-BR were analysed over 12 months. Major clinical response (MCR) was defined as a SLEDAI-2K ≤4 at 12 months. Deprivation was measured using English indices of deprivation 2019 decile (EID, 1= most deprived, 10=least). MCR was compared using multivariate logistic regression (reference group: White background; adjusted for age, gender and EID). Missing data were imputed using random forest in R V4.2.1 (package: missForest V.1.5). <h3>Results</h3> 1601 SLE patients (Female=1447 [90.4%], median age [IQR]: 39.9 [31.0-50.6] years) commenced therapy from September 2010-September 2022 (RTX: N=1177, belimumab: N=193, SOC: N=231). 905 (56.5%) were White, 233 (14.6%) were Black, 197 were Indo-Asian, 81 (5.1%) were Chinese/ East Asian, and 60 were of Multiple-Mixed background and 125 (7.8%) preferred not to say. 1,364 (85.2%) patients were taking glucocorticoids (GC) at baseline (median dose [IQR]: 7 [4.5-11.1] mg daily). MCR was achieved in 901 (56.3%) patients at 12 months. Black patients had a higher SLEDAI-2K score at baseline compared with white individuals (Figure 1). Black, East-Asian/ Chinese patients, and Multiple-Mixed ethnic background patients received a higher GC dose at baseline (Table 1). Black, Indo-Asian and Multiple-Mixed background patients were more likely to be in a lower EID. In patients receiving RTX, Black (adjusted OR 0.36 [95%CI 0.25-0.52]) and Indo-Asian (0.42 0.18-0.96)) patients were less likely to achieve MCR. In patients receiving belimumab, Black (0.65 [0.44-0.96]) and Indo-Asian patients (0.29 [0.09-0.93]) were also less likely to have an MCR. Absolute reduction in SLEDAI-2K was similar for each ethnic group. <h3>Conclusion</h3> Although absolute reduction in disease activity was similar across ethnic backgrounds, obtaining a MCR following treatment was lower in Black and Indo-Asian patients, in part reflecting higher baseline disease activity, but not explained by level of social deprivation; an observation not confined to a single treatment. There is a need for investigation into the drivers of these inequitable outcomes and reappraisal of treat-to-target strategies in these populations. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Sarah Dyball: None declared, Mia Rodziewicz: None declared, Emily Sutton: None declared, Ben Parker: None declared, Ian N. Bruce Speakers bureau: GSK, Astra Zeneca, Janssen, Consultant of: GSK, Astra Zeneca, Aurinia, Lilly, Grant/research support from: GSK, Astra Zeneca, Janssen.